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General NPI Number Information
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NPI Number | 1558778233
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Entity Type | Individual
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Provider Name | MEGHAN WALLER
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Gender | Female
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 51600 HUNTINGTON RD STE 103
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City | LA PINE
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State | OR
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Zip | 97739-8887
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Country | US
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Telephone | 541-536-7443
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Fax |
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Provider Business Mailing Address
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Address Line | 805 SW INDUSTRIAL WAY STE 3
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City | BEND
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State | OR
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Zip | 97702-1093
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 65196
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60455582
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License Number State | WA
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